The first thing Julie Potyraj did after waking up on Nov. 9 was to check her calendar to see when her IUD was inserted. Panicked after Republicans vowed during the presidential campaign to roll back women’s health care initiatives, Potyraj wanted to ensure that her long-term birth control method would last through at least four years of a Trump administration.
She breathed a sigh of relief when the dates showed she was in the clear. As a long-term reversible form of birth control, an intrauterine device is placed inside a woman’s uterus. A hormonal IUD can work for up to five years, and a copper, nonhormonal IUD can last up to 12 years. They are among the most popular contraception options for women in the U.S. and around the world.
Potyraj also began discussing contraception options with her friends, encouraging others to look into various birth control methods soon, because the future of affordable contraception access felt uncertain.
“Even though many of them would not have considered an IUD otherwise, they thought that getting one was better than having no option,” said Potyraj, a master’s of public health candidate at George Washington University.
Danielle Rosen, a senior editor at CIA Medical, had a similar reaction after Trump was elected president. She made an appointment to get an IUD the same day and began stocking up on Plan B, also known as the morning-after pill, for “extra backup” for herself and her friends. Just in case.
Since the presidential campaign season, Republicans have promised to repeal Obamacare (while also vowing to entirely defund Planned Parenthood), but what, if anything, will replace it remains a mystery. The law, enacted in 2010, has made health insurance affordable for more than 22.5 million Americans who otherwise would have had to do without it. The policy also created more gender equality within health care — maternity and newborn care were made a required benefit in health plans, and preventive services and medicines were free of charge. Those services included birth control, including pills, IUDs, shots, implants and rings, for women who wanted them. The law also provided free breast pumps for new mothers.
Around 55 million women currently receive birth control without out-of-pocket costs, according to the National Women’s Law Center.
Data collected from the health care transparency company Amino Health found that consumers, especially women, would likely pay much more for preventive care if the Affordable Care Act were repealed. Depending on what were to replace it, insurance companies might not cover preventive care services. According to the firm’s independent data, 51 percent of privately insured workers have an annual deductible of $1,000 or more, so many routine exams and screenings would have to be paid for out of pocket. Of particular note, Amino found that after the repeal of the ACA, an IUD could cost a woman $1,000, a mammogram could cost $200, and a tubal ligation (i.e., getting your tubes tied) could cost $4,000. Under Obamacare, insurers must cover these procedures.
“The result could have an economic impact for both government and individuals. The unintended pregnancy rate, which is already too high, will once again rise and result in additional cost for the system and consequences for women having more children than they intended or can afford,” said Saundra Pelletier, leader of WomanCare Global, an international nonprofit that seeks to provide affordable women’s health care products to those in need. Pelletier noted that 45 percent of all pregnancies in the U.S. are unintended, at an annual cost to taxpayers of $9.4 billion for expenses such prenatal care, labor and delivery, along with postpartum and infant care. With the rollback of women’s reproductive health access, that number could go much higher.
While waiting to see what the administration and Congress come up with to replace the law, many women are already preparing for less accessibility to birth control and family planning measures in the future.
Many mothers of teen girls have also expressed concern. Stephanie Dolgoff, a New York-based writer and editor, said she’s had frank discussions with her 13-year-old daughter about sex (“much to her mortification”), and while the girl isn’t sexually active now, Dolgoff said she hopes that her daughter will talk with her directly about birth control options when the time comes. And if, for some reason, she doesn’t feel comfortable, “I plan to make sure she knows where the condoms are and can access them without my having to know about it. If I know she’s sexually active for sure, I will get her an IUD or the pill and pay for it.”
And “if by some crazy, medieval decree, teenagers are not allowed birth control at all anymore, I will take her to a country that is not as moronic and sex-negative and anti-woman as this one and get her fitted with an IUD, and I will consider myself privileged to have that option,” added Dolgoff, who noted that this is an option many other families wouldn’t be able to afford.
In January, Planned Parenthood reported a 900 percent increase in demand for intrauterine devices since Trump’s election. In a CNN interview, Cecile Richards, president of Planned Parenthood, said that women are “desperately concerned that they might lose their access to health care” in Trump’s America.
Other data seems to back Richards’ claim. In January, new research from AthenaHealth showed a spike in IUD prescriptions and procedures of 19 percent between October and December of 2016.
Stephanie Long, MD, a family medicine physician with One Medical in San Francisco, said that anxiety among female patients has been notably higher since Trump’s election victory, and she often fields questions from women about how to prepare for an uncertain future in reproductive health care. Many patients have inquired about the cost of birth control in the future and whether they can get a year’s supply or more, she said.
“Women are willing to undergo the discomfort of a premature IUD removal and reinsertion to be assured that they can have their method of choice throughout the potential duration of the current administration,” said Long.
More than 99 percent of women ages 15 to 44 in the U.S. who are sexually active have used at least one kind of contraceptive method. Married women are more likely to be using contraception than never-married women (77 percent vs. 42 percent), largely because married women are more likely to be sexually active, according to the Guttmacher Institute.
“The ability to delay and space childbearing is crucial to women’s social and economic advancement,” according to the Guttmacher Institute. “Women’s ability to obtain and effectively use contraceptives has a positive impact on their education and workforce participation, as well as on subsequent outcomes related to income, family stability, mental health and happiness, and children’s well-being.”
Some states, such as New York, have already introduced measures that would require insurers to still offer contraceptives without a co-pay if the Obamacare-era benefit is not included in the replacement law. But most haven’t acted yet.
As the country waits for the fallout from a potential Obamacare repeal, WomanCare’s Pelletier has a message for lawmakers considering a replacement. Affordable access to contraception, she said, is a measure toward “breaking the cycle of poverty and its implications for society by allowing girls to stay in school and women to rise in the workforce, gaining in equality and equity.”
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